'---------  |  ------------------- Improving Your Efficiency
'  .~. .~.  |.~.                           Andrew P. Holupka
' (__|/|__)/|  |/                        4850 White Cloud Rd
'      |                                 Leechburg, PA 15656
PROGRAM: VB 4-to-3
VERSION: 9610 (Shareware Version)


                  REGISTRATION INFORMATION

Thank you for taking the time to register this program.
Please fill out this form and mail it along with your
payment to the above address. In return, you will receive
the most recent, non-shareware version of this program
as well as free technical support.
____________________________________________________________

    Name: __________________________________________________

   Email: __________________________________________________

 Address: __________________________________________________

    City: _______________ Region: ________ PostCode: _______

 Country: __________________ Phone Number: _________________

____________________________________________________________
Please indicate the amount enclosed:
  [x] Registration Fee (required) . . . . . . . . $____30.00
      (program will be delivered thru email)

  [ ] Shipping and Handling (optional)  . . . . . $_________
      (program will be delivered on 3.5HD disks)
      [ ] USA, Canada, Mexico: $6.00
      [ ] All other countries: $13.00

  [ ] 6% sales tax (required for PA residents)  . $_________

                                           TOTAL: $_________
Notes:
 * Make payment payable to Andrew P. Holupka.
 * Payment must be in US funds drawn on a US bank.
 * Please allow four to six weeks for delivery.
____________________________________________________________

                       QUESTIONAIRE
Where did you get this program?
 [ ] A friend gave it to me. (Please thank them.)
     If the friend is also registered, we'll thank them too.
     Their name: ___________________________________________

 [ ] Downloaded from the internet. Site: ___________________

 [ ] Downloaded from an online service. Name: ______________
     (ex: Compuserve, America Online, Genie, Delphi)

 [ ] Downloaded from a BBS. Name: __________________________

 [ ] Purchased from a catalog. Name: _______________________

 [ ] Purchased thru retail. Name: __________________________
     (ex: stores, flea markets, computer fairs, etc.)

 [ ] Other: ________________________________________________

 [ ] Unknown

Any comments or suggestions for improving the program:



Any suggestions for new programs that you would like:



9610                                     email: aph@slip.net
aph